Individual provider Active NPI

Michael R Humphrey, MD

  • Emergency Medicine Physician
  • Lima, OH
National Provider Identifier
1679511497
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
35057636 Issued in OH
Practice address
730 W Market St
Lima, OH 45801-4602
Phone
(419) 227-3361
NPI assigned
Jun 3, 2006
Last updated
Nov 1, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35057636 OH Primary

Addresses

Primary practice location

730 W Market St
Lima, OH 45801-4602

Mailing address

4750 Hempstead Station Dr
Kettering, OH 45429-5164
Phone (800) 875-0136

Other identifiers 3

IdentifierTypeStateIssuer
0722883MedicaidOH
P00088335OtherOHMEDICARE RR
000000317841OtherOHANTHEM/BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040126000926 OH Practitioner - Emergency MedicinePractitioner - Internal Medicine 7810891306 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35057636OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Emergency Care Services, Inc. Emergency Medicine CurrentSince Apr 15, 2015 Accepting new patients
New Century Medical Observation Services of Lucas County, Inc Emergency Medicine Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Sidney Emergency Physicians, Inc. Emergency Medicine Past Accepting new patients
Lucas County Emergency Physicians Inc Emergency Medicine Past Accepting new patients

Locations

730 W Market St
Lima, OH 45801
Phone (419) 226-4310

2600 Navarre Ave
Oregon, OH 43616
Phone (419) 696-7200

2213 Cherry St
Toledo, OH 43608
Phone (419) 251-4283

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1679511497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 HEMPSTEAD STATION DR",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454295164",
            "telephone_number": "800-875-0136",
            "fax_number": "937-619-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 W MARKET ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458014602",
            "telephone_number": "419-227-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35057636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0722883",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00088335",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM/BCBS",
            "identifier": "000000317841",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lima, OH

Sources for this page

Verify at the official NPI Registry.